“There is no profit to be made from new antibiotics (which is a major problem).”

“Pieter Winsemius didn’t know what he heard. Livestock farmers and their families who were ‘put aside’ when they were hospitalised because of their infection with resistant bacteria. Tremendous piles of reports and the policymakers who decided on ‘further research’. As long as they didn’t have to do anything. This is urgent, concluded former minister Winsemius, who at the time, in 2009, was a member of the Scientific Council for Government Policy.

Nine years later, a great deal has happened, for example to reduce the use of antibiotics. However, there has been little progress towards solving the most important problem. The world urgently needs new medicines against bacteria that have become insensitive to current drugs. The image of fear: millions of people dying of diseases that are still easy to combat.

And so the Access to Medicine organisation is now arguing for government support for highly profitable pharmaceutical companies. That is the main reason why the new panaceas are not yet in place: new antibiotics do not yield a single cent. We have to face up to the market failure’, said Gabrielle Breugelmans of Access to Medicine at a recent meeting with pharmaceutical companies in The Hague.

It is remarkable that Breugelmans in particular says something like this. Access to Medicine is an organisation with a long tradition in the capitulation of the pharmaceutical industry. And now the same organisation is arguing for government support – an ‘incentive’ in the words of Breugelmans.

Unattractive business model
The market failure referred to by Breugelmans is a specific problem for antibiotics: new drugs are only used as a last resort, precisely to prevent the bacteria from developing resistance to the new drug.

This paradox results in an extraordinarily unattractive business model. Why should pharmaceutical companies invest hundreds of millions of euros in the development of a new medicine when it is clear in advance that doctors will hardly use it?

The observation is not new. Two years ago, pharmaceutical companies made a joint appeal to the effect that a different revenue model was necessary to stimulate the development of new antibiotics. A company that develops a new, well-functioning antibiotic should be able to count on a fee agreed in advance. In other words: dissociated from the use of the product.

Such a compensation has not yet been paid, and whether it will be paid is questionable. The Dutch government has not yet taken a position on its desirability, as Minister Bruno Bruins of Medical Care announced in a letter to the Lower House of Parliament at the beginning of this year.

A British committee of inquiry led by Jim O’Neill, the former chief economist of Goldman Sachs, came up with a solution in June: to make all other medicines more expensive. O’Neill wants to use its earnings to finance a one-time fee of €1 billion for the introduction of each new antibiotic. According to O’Neill, pharmaceutical companies are now doing far too little. Only three companies, GSK, Roche and Shionogi, would be seriously involved.

Access-to-Medicine’s opinion is more positive. The organisation states that at least eight large pharmaceutical companies are seriously working on the development of new antibiotics.

What is certain is that governments have not been indifferent. What is more, it rains initiatives. Four of the largest international partnerships, including the EU and the WHO, have a total budget of approximately €1 billion to combat resistance. In the Netherlands, former Minister of Health Edith Schippers was a driving force. Partly as a result of her work, for example, the Netherlands Antibiotic Development Platform was established.

Elephant in the room
The chairman of that platform, Kees de Joncheere, also sees the lack of a revenue model for new antibiotics as a crucial problem. He speaks of ‘the elephant in the room’; nobody likes to talk about it.

Maarten van Dongen also spoke at the meeting in The Hague, where Breugelmans and De Joncheere were guests. Van Dongen is a microbiologist whose neighbour died at the hands of a resistant bacterium. The drama prompted him to set up AMR Insights, an organisation that focuses on the exchange of up-to-date information on resistance. AMR, or Antimicrobial Resistance, is the English term for microbial resistance. It is an umbrella term that indicates that not only bacteria, but also viruses, fungi and parasites develop resistance and pose a new danger.

Van Dongen pointed out that the development of new antibiotics is only one of the many paths to be followed in order to avert the doomsday scenario of 10 million deaths per year after 2050. Another path is prevention of infectious diseases. For example, the use of vaccines can help to reduce the use of antibiotics, which also makes bacteria and other pathogens less susceptible to them. Better and faster diagnostics – which bacterium is the culprit? – may also result in a more selective use of antibiotics.

Also one of the largest pharmaceutical companies in the world, the American Merck & Co, which operates in Europe under the name MSD, sees more future in vaccines to prevent infections, appeared in The Hague. The company is still developing new antibiotics and other anti-microbial drugs, said medical director Caroline Doornebos of Merck Netherlands, but she too stressed the importance of ‘a different revenue model’.

Antibiotics are already a regular cost item rather than a source of income. For example, Merck currently holds various antibiotics in stock, more or less for emergencies, which the company hardly sells at all. According to Doornebos it is a kind of charity, originating from a sense of duty.

No more bonuses
Farmers also contradict O’Neill’s British findings, claiming that in 2016 alone they invested $2 billion in the development of new antibiotics. At the same time, several companies have implemented measures to restrict the use of existing antibiotics. Four large pharmaceutical groups, for example, no longer award bonuses to their salesmen of antibiotics on the basis of sales achieved.

Pieter Winsemius, who remembers the lively illegal trade in antibiotics for pigs, has not been dealing with the subject for some time. But the former minister is sceptical. I don’t know if so much has actually happened in recent years. What I do know is that the parties involved always say so.

Source: Financieel Dagblad (in Dutch)


What is going on with AMR?
Stay tuned with remarkable global AMR news and developments!

Keep me informed